Improving Quality

In this months (January 2012) Clinical Services Journal, there is an interesting report on initiatives in transfusion in joint surgery that improve patient outcomes, reduce post-operative complications and reduce the length of stay. (page 59 to 62) One very relevant piece of information is that an audit showed that patients who had a donor transfusion spent 3.8 to 4.5 more days in hospital than those who did not receive a transfusion.

The chances of readmission were also higher for those who received a donor transfusion – 21% versus 5% for knee patients and 12% versus 6% for hip patients. Patients who had a preoperative Haemoglobin (Hb) level of less than 12 g/dl are at high risk of transfusion (50% likelihood of transfusion), between 12 – 13 g/dl are at medium risk (up to 40% likelihood) and those with Hb of 13 g/dl are considered to be low risk of transfusion (10%).

To avoid a donor transfusion, increasing the Hb level pre-operatively is one option – patients can do this by taking extra iron supplements for the weeks leading up to admission. If they are seen at a pre-operative clinic, doctors may prescribe intravenous iron or even erythropoetin to quickly increase the Hb level. Patients that are admitted with an Hb less than 13 g/dl still have the option of getting their own blood back through cell salvage intra-operatively.

This will mean that they may still avoid the complications of donor transfusion. For improved quality of care, reduced hospital stay and reduced complications, using Mobile Blood Savers service will help.